424 
NASAL GLEET. 
to-day, the nasal discharge has been gradually diminishing once 
more. Still, there remains a trifling running, and this is evidently 
purulent, and can be perceived to be offensive : I therefore re- 
solved to have recourse again to the trephine, this time making 
the opening into the maxillary sinus. To my surprise, however, 
after the trephined portion of bone had been removed, no discharge 
of air took place, as always happens when the passages are in 
their normal pervious condition; but, on the contrary, when I 
came to look into the aperture, I found the inside apparently full 
of callous effusion, partly osseous, partly cartilaginous, by which 
the interior of the sinus had become blocked up. There was, 
therefore, no possibility of making use of any injection : repeated 
attempts were made to force fluid through the cancellated structure 
within, but all to no purpose. 
February 24/A. — I have been waiting for the wound last 
made to heal up before I ventured to make another perforation 
into the same sinus. This I did this morning, in the usual situa- 
tion for trephining, immediately over the anterior portion of the 
maxillary ridge , the former opening having been made into the 
supero-posterior part of the sinus. Still, no air rushed out on 
perforating the sinus again, neither could liquid be made to enter 
by forcing with the syringe. Here, then, was another failure; the 
discharge from the nose continuing, though scanty, and the ef- 
fluvium from the affected nostril still being perceptible. 
March $th . — The wound last made with the trephine being 
nearly healed up, it was determined once more to open the frontal 
sinus, applying the trephine this time as near as practicable to the 
orbit, so as to avoid touching with it the bone which had already 
been perforated; and this shews the advantage of applying the 
trephine in the first instance as near as possible to the median 
line of the skull. No sooner was the insulated portion of bone 
perforated and displaced, than air rushed out as usual, though not 
with that seeming force or amount as happens in the case of un- 
obstructed condition of the passages. Tepid water injected, issued 
immediately through the nostril, bringing with it a quantity of 
offensive yellow purulent matter, but no grumous clots, nor any 
matter that was green in hue. After the cleansing with water, 
the kreasote injection is to be used; and this practice is to be pur- 
sued morning and evening as heretofore. 
March 22 d . — The injections have been regularly administered, 
morning and evening. For the first week after their re-commence- 
ment copious defluxions of matter were brought away by them, 
fcetor being strong at the time, and the swelled gland underneath 
the jaw increased in magnitude. In fact, as very commonly hap- 
pens, for some days after commencing injecting every symptom 
